Symptomatic vertebral hemangiomas during pregnancy

Abstract

<jats:p>Symptomatic vertebral hemangiomas during pregnancy are rare, as only 27 cases have been reported in the literature since 1948. However, symptomatic vertebral hemangiomas can be responsible for spinal cord compression, in which case they constitute a medical emergency, which raises management difficulties in the context of pregnancy. Pregnancy is a known factor responsible for deterioration of these vascular tumors. In this paper, the authors report 2 clinical cases of symptomatic vertebral hemangiomas during pregnancy, including 1 case of spontaneous fracture that has never been previously reported in the literature. The authors then present a brief review of the literature to discuss emergency management of this condition. The first case was a 28-year-old woman at 35 weeks of gestation, who presented with paraparesis. Spinal cord MRI demonstrated a vertebral hemangioma invading the body and posterior arch of T-3 with posterior epidural extension. Laminectomy and vertebroplasty were performed after cesarean section, allowing neurological recovery. The second case involved a 35-year-old woman who presented with spontaneous fracture of T-7 at 36 weeks of gestation, revealing a vertebral hemangioma with no neurological deficit, but it was responsible for pain and local instability. Treatment consisted of postpartum posterior interbody fusion. With a clinical and radiological follow-up of 2 years, no complications and no modification of the hemangiomas were observed. A review of the literature reveals discordant management of these rare cases, which is why the treatment course must be decided by a multidisciplinary team as a function of fetal gestational age and maternal neurological features.</jats:p>

Spinal stroke in a pregnant female with an endodermal cyst of the cervical spinal cord (a case report and literature review)

“…Так, в недавней работе А. Moles и соавт. [3], посвященной симптоматическим верте-бральным гемангиомам (одной из наиболее часто встречающихся опухолей позвоночника) у беремен-ных, отмечается, что с 1948 г. в литературе появи-лись описания всего 27 таких наблюдений. Опухоли спинного мозга у беременных встречаются еще ре-же.…”

Low Back Pain in Pregnancy: Investigations, Management, and Role of Neuraxial Analgesia and Anaesthesia: A Systematic Review

“…Osteoporosis in pregnancy has been associated with vertebral [48] and sacral stress fractures [60] . Other rare pathologies may include osteomyelitis [99] and spinal tumours [91,100] . A detailed account of the aetiology of low back and pelvic pain in pregnancy can be found in other publications [11,12] .…”

“…Three case reports [47,48,50] and one literature review [91] described surgical management of vertebral fractures and vertebral hemangiomas respectively. Surgery was generally successful in relieving pain and restoring function without increased morbidity or mortality.…”

“…The underlying pathologies associated with these presentations included herniation of intervertebral discs [18,[38][39][40][41][42][43][44][45][46] , vertebral hemangiomas [51] , spinal body tumour [44] , and tuberculosis [44] ( Table 1 ). MRI was also used to investigate LBP in pregnant women with co-existing hip pain, with 3 studies reporting inflammation of the SIJ as the underlying cause [52][53][54] and 10 studies describing sacral fractures [55][56][57][58][59][60][61][62][63][64] .…”

“…MRI was most commonly used modality (17 publications) for diagnosing the cause of LBP, especially when LBP was associated with neurological symptoms in the lower limb such as radicular pain, paraplegia and/or cauda equina [18,[38][39][40][41][42][43][44][45][46][47][48][49][50][51] . The underlying pathologies associated with these presentations included herniation of intervertebral discs [18,[38][39][40][41][42][43][44][45][46] , vertebral hemangiomas [51] , spinal body tumour [44] , and tuberculosis [44] ( Table 1 ).…”